Sandeep Rao

This past Memorial Day weekend marked a time for friends and families to recall fond memories of service members lost on the battlefield. But, for many soldiers returning from active war zones, painful jarring memories in the form of post-traumatic stress disorder (PTSD) leave these emotionally wounded warriors restless, anxious, and potentially suicidal.

Federal numbers indicate the toll of mental illness on returning soldiers and veterans through suicide over the past two years has begun to exceed combat casualties during the same period of time. Worse yet, many of these soldiers who actively seek help are stranded for months on end awaiting mental health referral by an undermanned Veterans Administration (VA) health system.

A 2008 Rand study estimates 1 in 5 veterans returning from Iraq and Afghanistan suffer from PTSD. The sheer number of new entrants fresh from combat zones has overwhelmed the VA health system. Over 1 million veterans are on the waiting list for decisions on disability claims with an additional 10,000 new patients entering the VA health system each month, according to a lawsuit filed against the VA by veterans advocacy groups.

These staggering numbers persuaded the 9th US Circuit Court of Appeals to rule against the VA two weeks ago, finding them responsible for "unchecked incompetence" and ordering an immediate overhaul of its mental health programs. The decision awaits potential appeal up to the US Supreme Court.

But, delays through appeal will do nothing to help stem the tide of veterans currently seeking help. The Veterans Crisis Line for suicide prevention fielded over 14,000 calls this past April, the highest monthly volume in the 4-year history of the program. An alarming average of 18 veterans commits suicide every day, according to the 9th Circuit's decision. Thus, weeks and months of waiting for medical treatment translate into untold numbers of unnecessary deaths.

It's not just young soldiers returning fresh from the war zones of Iraq and Afghanistan who have overwhelmed VA patient rolls. Rising numbers of Vietnam veterans have begun to enter retirement, and the sudden lifestyle change has aggravated recurrence of heightened startle response and insomnia-like symptoms.

Many of these older veterans were previously characterized as suffering immature personality disorder, rather than PTSD, simply because the diagnosis of PTSD was not medically known at the time. Subsequently, these veterans with a psychiatric misdiagnosis were unable to seek medical care due to the pre-existing diagnosis of a personality disorder.


Sandeep Rao

Sandeep Rao MD, MBA is a fellow at Johns Hopkins Hospital specializing in vascular and interventional radiology.